From the Field

Finally: Pro-psychology hospital regulations in California

After more than 20 years of legal and legislative wrangling, regulations intended to allow California psychologists to be in charge of their patients’ inpatient hospital care have finally gone into effect

By Legal and Regulatory Affairs Staff

April 28, 2010 — Following more than twenty years of legal and legislative wrangling, the California Department of Public Health finalized on March 3, 2010 regulations intended to allow psychologists to be in charge of their patients’ inpatient hospital care without supervision from psychiatrists. The regulations went into effect on April 3.

Among the changes, the regulations:

Affirm the rights of a licensed health care practitioner acting within the scope of his or her professional licensure, as a member of the medical staff, to assume overall care of the patient.

Require that psychologists be members of the medical staff of state-owned hospitals. This requirement is set forth in statute, but has reportedly not been followed. The regulations also make clear that hospitals not owned by the state may include psychologists on the medical staff.

Allow “licensed healthcare practitioners” to admit/discharge patients, to order restraints, to serve as the contact in emergencies when the attending is unavailable, and to perform certain other duties that were previously limited to physicians.

These new regulations implement the 1990 court case CAPP v Rank, in which the California Supreme Court ruled that California regulations prohibiting hospitals from allowing psychologists to be in charge of diagnosing and treating patients violated state law.

Despite the Supreme Court’s clear ruling on this issue, the fight for greater patient access to psychological services and the struggle to end discrimination against psychologists in California hospital settings ensued for twenty more years.

Bill Safarjan, PhD, brought together a group of California psychologists who, with help from the California Psychological Association (CPA), formed Psychology Shield, a not-for-profit corporation created to press for implementation of CAPP v. Rank. CPA, Psychology Shield, and the American Psychological Association (APA) have spent many years seeking revisions to state regulations governing hospitals.

Citing CAPP v. Rank, the California Department of Health Services (DHS) acknowledged that its regulations violated the statute prohibiting discrimination against psychologists by state-owned hospitals and, in certain cases, hospitals not owned by the state. To address this issue, in the hospital regulations finalized last month, DHS removed language that explicitly discriminated against psychologists. DHS also replaced the word “physician” with the term “licensed healthcare practitioner acting within the scope of his or her license” in several areas and added “psychologist” in certain places that previously only included “physician.”

APA testified in California on these regulations and submitted two letters supporting the regulations overall, while requesting some changes. Many, though not all, of the changes requested were ultimately adopted.

“We believe that, overall, the revised regulations are advantageous for psychology and will have national implications,” says Maureen Testoni, director of legal and regulatory affairs for the APA Practice Directorate. The California regulations "go farther than the vast majority of state laws in allowing psychologists to independently manage their patients’ care.”